Mini-Scissor Versus Bipolar Twizzle in Ambulatory Hysteroscopic Metroplasty: A Prospective Randomized Study

Abstract

Objective: The goal of this study was to compare mechanical (cold scissor) and electrosurgical metroplasty (bipolar twizzle) in terms of feasibility and pain scoring during ambulatory-based hysteroscopic metroplasty for short, narrow-based uterine septae. Materials and Methods: Forty women, with recurrent abortions or infertility, with short narrow-based septae <2 cm diagnosed by transvaginal ultrasound and hysterosalpingogram (HSG) were included in the study. The patients were randomized into two groups of 20 patients each. In group A, metroplasty was performed with a cold mini-scissor (mechanical resection). In group B, metroplasty was performed with a bipolar twizzle (electrosurgical resection). None of the patients were given anesthesia or analgesia. Metroplasty was scheduled in the early proliferative phase of each patient's menstrual cycle, without pharmacologic preparation. The Versascope® hysteroscopy system was used. Through the expanding plastic collapsible channel, insertion of a 7-Fr semirigid mechanical instrument (the mini-scissor) or a 5-Fr bipolar electrode (the twizzle) was performed, allowing ambulatory metroplasty to be performed. All patients had postoperative HSGs 3 months later, after exclusion of pregnancy, to evaluate objectively the complete resection of their septae. Results: No significant difference was found between both groups in terms of operative time and fluid deficit (12.68±2.08 versus 12.08±2.62) and (519±118.59 versus 480±106.01), respectively. Pain scores were significantly higher in the bipolar twizzle group than in the mini-scissor group. The pain scores had (4.01±0.68 versus 6.98±1.28) a p significance of <0.05. Conclusions: Ambulatory-based hysteroscopic metroplasty, using either a mini-scissor or bipolar twizzle, is a safe and effective procedure. Electrosurgical electrodes induce significantly higher pain scores than mechanical cold instruments, necessitating careful instrument selection when treating patients in whom more pain is anticipated (e.g., previous cesarean section, chronic pelvic pain, or anxious or menopausal women). If an electrosurgical electrode is the only available device, a preoperative analgesic is recommended, especially for such patients. (J GYNECOL SURG 30:147)